New research finds annual funding for harm reduction in low- and middle-income countries is 13% of the required amount to prevent HIV among people who inject drugs

LONDON (23 July 2018) – Funding for harm reduction services in low- and middle-income countries (LMICs) is in crisis, according to a new report from Harm Reduction International launched to coincide with the 2018 International AIDS Conference. It found that in 2016, harm reduction funding totalled just 13% of the $1.5 billion that UNAIDS estimates is required annually to prevent HIV among people who inject drugs, one of the most at-risk populations for HIV.

New HIV infections among people who inject drugs increased by one-third from 2011-15. Harm reduction interventions—such as opioid substitution therapy (OST) and needle and syringe programmes (NSP)—are cost-effective and well-evidenced in preventing the spread of blood-borne viruses.

The report, ‘The lost decade: Neglect for harm reduction funding and the health crisis among people who use drugs,’ finds that overall funding for harm reduction in LMICs—including from international donors, domestic governments and philanthropic organisations—has flat-lined since 2007. This is despite governments in 2015 setting the ambitious goal to end AIDS by 2030.

Contributions from international donors (which account for two-thirds of all funding) dropped almost 25% in a decade (2007-16), while harm reduction funding allocations from the biggest international donor, the Global Fund to Fight AIDS, TB and Malaria, were almost one-fifth less in 2016 compared to 2011.

Catherine Cook, Harm Reduction International’s head of research and the report’s co-author, said: “It is evident that people who use drugs are being neglected in the global HIV response. The withdrawal of donor funding for harm reduction is leaving already-marginalised communities at further risk of HIV and hepatitis C, and calls into questions whether donors are serious about hitting their global health targets.”

The report also found that while a small number of LMIC governments have increased domestic funding for harm reduction services—for example, Malaysia and Vietnam—there are too many cases of donor withdrawal leading to service closures. Many LMIC countries have punitive drug laws that criminalise and discriminate against people who use drugs, further hindering their access to lifesaving HIV prevention and treatment, along with other healthcare services.

Michel Kazatchkine, member of the Global Commission on Drug Policy, said: "The funding gap for harm reduction is a major concern, particularly in Eastern Europe and Asia where new HIV infections among people who inject drugs continue to grow at high rates. Harm reduction is a well-evidenced health intervention, yet too many governments ignore it because of the stigma associated with drug use. This must change.”

The report recommends that donor agencies, such as the Global Fund and PEPFAR, increase their funding for harm reduction interventions and put in place gradual transition plans when funding is eventually withdrawn. It further states that domestic governments should begin to redirect funds from drug law enforcement to lifesaving harm reduction interventions. Harm Reduction International’s 2016 research found that redirecting 7.5% of the global drug law enforcement spend (approximately $100 billion annually) would end AIDS among people who inject drugs by 2030.